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EPC Partner's Guide (continued)

Chapter 3: Roles and Responsibilities

Partners

Organizations that nominate topics that are selected for EPC evidence reports and technology assessments assume the role of partners of AHRQ and the EPCs. In some instances, there may be multiple partners for a given topic. AHRQ places high value on its relationships with partners. Partners have defined roles and responsibilities:

Once a topic is selected, a partner must:
- Participate in conference calls to discuss the goals and objectives for the topic with the AHRQ Task Order Officer (TOO) and EPC assigned to the topic.
- Be available to the EPC as a source of information and expertise as it develops the evidence report or technology assessment.
- Appoint one representative to the technical expert panel designated for an EPC report. This partner representative will be available for consultation on the scope of the topic and questions, literature sources, identification of experts and, if requested by the EPC, serve as an external peer reviewer of the draft EPC report.
Once an evidence report or technology assessment is published, partners are expected to:
- Commit to the timely translation of the EPC report into their own quality improvement products (e.g., clinical practice guidelines, performance measures), educational programs or coverage and reimbursement policies, as appropriate.
- Disseminate these partner-developed products to appropriate members, populations or other target audiences.
- Participate in efforts to measure the use and impact of the products, programs or policies derived from EPC reports.
- Provide data regarding translation, dissemination, use and impact measurement activities to AHRQ so that the EPC program can be assessed and improved. The EPC Coordinating Center will collect and organize information about these activities from partners using a Web-based survey and routine telephone communication.
Partners may not:
- Seek to alter the scope of work for an EPC report without consulting the AHRQ TOO.
- Determine the composition of an EPC's technical expert panel or manage the panel's deliberations. The technical expert panel, of which the partner representative is an equal member, may be asked by the EPC to provide substantive input from time to time. Consistent with its objective search strategy and review of relevant evidence, EPCs may exclude articles that partners may have published or cited (e.g., in their original topic nomination).
- Communicate directly with the EPC while the project is ongoing. All communication from the partner should go to the AHRQ TOO and communication throughout the process is important to ensure that the report meets the partner's needs. However, partner organizations may contract directly with an EPC after the report has been published. This may allow partner organizations to tap EPC content expertise as they develop guidelines, quality measures or other products based upon the findings of the reports.
- Edit the content of the final report produced by the EPC. The partner representative appointed to the technical expert panel may review the draft report as a member of the larger external peer review group and provide review comments. The EPC is responsible for considering all review comments and modifying the final report to incorporate substantive comments, as appropriate. AHRQ reviews peer review comments and the disposition of those comments.
One of the key attributes of the EPC program is ensuring that partners plan for and actively participate in translation and dissemination of EPC reports on their nominated topics. When AHRQ is considering whether to designate a new topic for EPC review, it will review the past performance (if any) of the nominating partner with regard to translation and dissemination of any previous EPC reports.

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AHRQ

AHRQ selects topics from the pool of nominated topics, funds the EPCs and acts as a bridge between the partners and EPCs. In particular, this is the responsibility of AHRQ's Center for Outcomes and Evidence (COE), with assistance from the EPC Coordinating Center. AHRQ has contractual relationships with the EPCs to produce the evidence reports. As AHRQ contractors, the EPCs are accountable to AHRQ under the scope and terms of these contracts. AHRQ Project Officers (POs) and TOOs are responsible for the technical monitoring of the EPC contracts, including facilitating communication between partners and EPCs. All partner communication with EPC staff is conducted through the appropriate AHRQ PO and/or TOO. Any communication not conducted directly through the AHRQ PO or TOO should be reported to the PO or TOO.

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EPCs

EPCs conduct evidence reviews based on topics nominated by partners and funded by AHRQ. They also may update prior evidence reports, provide technical assistance to facilitate translation of reports and undertake methods research for the EPC program. During the course of developing evidence reports, EPCs may do the following:

Participate in conference calls to discuss goals and objectives of work assignment, proposed search strategy, etc. At least one of these calls will be conducted at the inception of a topic assignment and will include AHRQ staff and representation from the partner organization. The EPC will submit a summary of the discussion and decisions to the call participants.
Submit a comprehensive work plan covering the assessment and refinement phase, proposed literature search and review (abstracts and full text), inclusion/exclusion criteria, criteria for evaluating the quality of studies and rating the strength of overall body of evidence, etc.
In consultation with the AHRQ TOO, identify a set of qualified individuals (e.g., five to eight) to comprise a technical expert panel. These typically include one or more physicians (e.g., primary care and specialist), professional society representatives, health care purchaser representatives, partner representatives, and other content and methods experts. The EPC will consult with these panelists, as needed, in developing its evidence report.
Conduct a preliminary assessment of the scientific literature for Federal partners to ascertain whether there is sufficient evidence to support a comprehensive systematic review and analysis.
Refine the preliminary questions and identify any necessary additional questions (However, such preliminary reviews usually are undertaken by the EPC Coordinating Center).
Systematically search, abstract, review, and analyze the scientific evidence for each question.
Identify peer reviewers to ensure input from a broad range of clinical and professional interests for a particular topic and submit a draft report to these individuals. The EPC will invite the partner organization to review and comment on the draft evidence report via a member of this external peer review group.
Produce a final evidence report and appendices in compliance with the format provided by AHRQ.
Engage in translation and dissemination activities related to reports they author, and/or measure the impact of those reports.

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EPC Coordinating Center

The EPC Coordinating Center works closely with AHRQ and the partners. Operated by The Lewin Group as a contractor to AHRQ, the Coordinating Center has several responsibilities related to supporting partners' involvement in the EPC program. Among these, it is available to provide technical assistance to partners, as noted below.

Conducts preliminary reviews (not evidence reports) of the quality and relevance of the available literature and related information pertaining to most nominated topics. AHRQ uses this information to help select topics for assignment to EPCs.
Supports AHRQ in setting priorities for updating prior EPC reports. This includes examining changes in available evidence, the quality and relevance of that evidence and other developments that would merit updating a report.
Collects information from partners, EPCs and non-Partner organizations on translation of EPC reports into guidelines, performance measures, educational curricula and other products; dissemination of these products; and the use and impact of these products.
Provides technical assistance to partners in such areas as:
- Framing evidence questions for topic nominations.
- Translating EPC reports into partner-developed products.
- Disseminating partner-developed products to memberships and other target groups.
- Measuring the use of partner-developed products and the impact of these on practice and policy.
Partners and potential partners may submit requests for technical assistance directly to the EPC Coordinating Center via E-mail to partnerTA@lewin.com.
In cooperation with AHRQ, organizes an annual conference on Translating Research Into Practice (TRIP).
Provides other assistance as needed to AHRQ in support of the EPC Program.
The EPC Coordination Center does not engage in the following activities:
- Select EPCs.
- Contract with EPCs.
- Manage EPC contracts.
- Select or assign topics for evidence reports.
- Conduct systematic reviews or produce evidence reports in the manner of EPCs.
- Evaluate the performance of the EPCs or partners.

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Chapter 4: Timeline for Topic Nomination, Evidence Review, Report Completion

The timeline for completion of an EPC report varies, depending on factors such as the type of report required, the number and clarity of questions, the volume of relevant evidence and the current workload of the EPC to which a topic is assigned. Topics with well-defined questions are likely to be produced in less time than those with broad and/or vague questions.

From the time of the publication of the annual Federal Register notice solicitation the benchmarks in the EPC report process are as follows.

Topic nomination due date: The due date is specified in the Federal Register and is approximately 50 to 60 days after publication of the notice. Topic nominations also are accepted on an ongoing basis for future years.
Topic selection and EPC assignment announcement: After preliminary reviews on nominated topics are completed, the topics are evaluated according to established criteria, selected, approved, and then assigned to the EPCs. The amount of time required for these steps can vary and depends on many factors including the number of nominations, quality of proposed key questions, and other ongoing agency activities. Other topics that are nominated and funded by Federal partners are assigned at other times throughout the year.
Report completion: Completion depends on the type of evidence report. Most comprehensive evidence reports take about 12 months from the time of topic assignment to completion.

When nominating a topic, partners may state a need for the information by a specific time. AHRQ will consider this as it reviews the topic nomination and defines the type of report that is most appropriate.

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Considering Past Performance for partner Organizations

Partners are expected to fulfill all of their roles and responsibilities as defined above. In determining partners' past performance, AHRQ will consider partner efforts in translation and dissemination of products derived from EPC evidence reports, as well as successes in use and impact of these products. Partners may seek technical assistance from the EPC Coordinating Center concerning strategies for translation, dissemination and impact measurement for partner-developed products based on EPC evidence report findings, as noted above.

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Translation, Dissemination and Impact Measurement

Partners

Partners' efforts to take the following steps are essential to the success of the EPC program:

Translate EPC evidence reports into practice guidelines, quality improvement products, educational curricula and/or health care policies.
Disseminate partner-developed products to their members and other appropriate target audiences.
Measure the use of these products by partner organization members and other target groups, and the products' impact on quality of care.

As noted above, the partners' topic nominations must include plans to translate and disseminate the findings of evidence reports and technology assessments. While these plans may change based on the findings of an EPC report and otherwise evolve, partners still should describe at the time of the nomination how they intend to make use of the EPC report findings.

Upon completion of an evidence report, the EPC Coordinating Center will contact the partner organization to ask about the status of plans for translation and dissemination. Periodically, the Coordinating Center will inquire about the partner's dissemination efforts. The Coordinating Center has developed a focused Web-based questionnaire to be completed by partners following release of the EPC report on their nominated topic and periodically for several years thereafter. This questionnaire requests information about partners' efforts to: (1) translate the evidence reports and technology assessments into clinical practice guidelines, performance measures, educational curricula, etc.; (2) disseminate the resultant derivative products; and (3) measure use of these products and their impact on clinical care, health behaviors, or policies.

Partners may seek technical assistance from the EPC Coordinating Center concerning approaches for translation, dissemination, and impact measurement by sending requests via E-mail to partnerTA@lewin.com.

EPCs

EPCs may engage in efforts to translate and disseminate their reports and measure their use and impact. The Coordinating Center works with EPCs to collect information about any activities in which the EPC has engaged related to the publication of evidence reports.

The Coordinating Center will ask the EPCs to identify a contact person or persons to communicate with the Coordinating Center about translation and dissemination efforts subsequent to release of reports. The Coordinating Center also seeks to track inquiries by other organizations to EPCs about forthcoming or previously published reports. The Coordinating Center will provide a log for the EPC contact person to record basic information about these inquiries and the contact person will transmit it to the Coordinating Center.

Resources on Effective Translation and Dissemination

Figure 3 provides examples of translation and dissemination activities and methods or indicators for monitoring their use. Partners may seek technical assistance from the Coordinating Center in these areas.

Figure 3: Framework for Considering Translation, Dissemination, and Use

Example	Activity
Example	Translation	Dissemination	Use and Impact
Clinical Practice Guidelines	Develop a process for generating guidelines Convene an internal workgroup Develop target group-specific guidelines Collaborate with other organizations	Distribute via Internet, CD, or hard copy to clinicians, patients, payers, others Publish in peer-reviewed journals Publicize in popular press Describe at conferences Make posters for sites of care	Clinical practice patterns Patient compliance, adoption of health behaviors Changes in payer coverage policies Community feedback Changes in health outcomes
Performance Measures	Developed/validate a new measure Test skills Create scale of acceptable performance Collaborate with other organizations	Distribute via Internet, CD, or hard copy to clinicians, patients, payers, standards-setting organizations Publish in peer-reviewed journals Distribute information of new measures to providers, patients	Routine schedule for use of measures Announcement of results Procedure for unsatisfactory performance Scores on measures Assessment activities implemented
Educational Curricula	Develop course materials Identify faculty to help develop and present curricula Collaborate with other groups in curriculum development	Publish in hard copy, video, other formats Publish as CME material in clinical journals Present at professional meetings Incorporate into academic programs Advertise curriculum in various media	Courses and participants in curriculum-base programs Changes in clinical practice, patient compliance/health behaviors Changes in health outcomes
Policy Change	Payer coverage policy Health care product or service regulation New or revised legislation	Implement or enact policy change Provide information on change to providers and/or patients Publish/post articles, FAQs explaining new policy	Compliance with policy Changes in clinical practice, patient compliance/health behaviors Change in utilization patterns, costs

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Appendix A: Graphic Overview of the EPC Process

[D] Select for Text Description.

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Appendix B: Resource Publications and Web Sites

The following publications and Web sites provide guidance on the development and use of evidence-based reviews in health care, including for translation, dissemination, and impact measurement of products derived from evidence reports.

Publications

Bero L, Grilli R, Grimshaw J, et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effectiveness Practice and Organization of Care Research Group. BMJ 1998;317(7156):456-8.
Berwick DM. Disseminating innovations in health care. JAMA 2003;289(15):1969-75.
Busse R, Orvain J, Velasco M, et al. Best practice in undertaking and reporting health technology assessments. Int J Technol Assess Health Care 2002;18:361-422.
Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ 2001;323:157-62.
Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London, England: BMJ Books; 2001.
Ferguson JH. NIH consensus conferences: dissemination and impact. Ann N Y Acad Sci 1993;703: 180-98.
Ferguson JH, Sherman CR. Panelists' views of 68 NIH consensus conference. Int J Technol Assess Health Care 2001;17(4):542-58.
Glanville J, Lefebvre C. Identifying systematic reviews: key resources. Evidence-based Medicine 2000;5:68-9.
Glanville J, Wilson P, Richardson R. Accessing the online evidence: a guide to key sources of research information on clinical and cost effectiveness. Qual Saf Health Care 2003;12:229-31.
Goldberg HI, Cummings MA, Steinberg EP, et al. Deliberations on the dissemination of PORT products: translating research findings into improved patient outcomes. Med Care 1994;32(suppl. 7):JS90-110.
Grol R. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418-21.
Haines A, Jones R. Implementing findings of research. BMJ 1994;308:1488-92.
Harris RP, Helfand M, Woolf SH, et al. Current methods of the US Preventive Services Task Force. A review of the process. Am J Prev Med 2001;20(3S):21-35.
Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. BMJ 1998;317(7153):273-6.
Haynes RB, Sackett DL, Gray JM, et al. Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions. ACP J Club 1996;125(3):A14-6.
Haynes RB, Sackett DL, Gray JA, et al. Transferring evidence from research into practice: 2. Getting the evidence straight. ACP J Club 1997;126(1):A14-6.
Haynes RB, Sackett DL, Guyatt GH, et al. Transferring evidence from research into practice: 4. Overcoming barriers to application. ACP J Club 1997;126(3):A14-5.
Kahan JP, Kanouse DE, Winkler JD. Stylistic variations in National Institutes of Health consensus statements, 1979-1983. Int J Technol Assess Health Care 1988;4(2):289-304.
Lyles A. Direct marketing of pharmaceuticals to consumers. Annu Rev Public Health 2002;23:73-91.
Mittman BS, Siu AL. Changing provider behavior: applying research on outcomes and effectiveness in health care. In: Shortell SM, Reinhardt UE, editors. Improving health policy and management: nine critical research issues for the 1990s. Ann Arbor, MI: Health Administration Press; 1992. 195-226.
Mittman BS, Tonesk X, Jacobson PD. Implementing clinical practice guidelines: social influence strategies and practitioner behaviour change. Qual Rev Bull 1992;18:413-21.
Muir Gray JA, Haynes RB, Sackett DL, et al. Transferring evidence from research into practice: 3. Developing evidence-based clinical policy. ACP J Club 1997;126(2):A14-6.
NHS Centre for Reviews and Dissemination. Accessing the evidence on clinical effectiveness. Effectiveness Matters 2001;5(1).
Oxman A, Davis D, Haynes RB, et al. No magic bullets: a systematic review of 102 trials of interventions to help health professionals deliver services more effectively or efficiently. Can Med Assoc J 1995;153:1423-43.
Oxman AD, Sackett DL, Guyatt GH. Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA 1993;270:2093-5.
Randall G, Taylor DW. Clinical practice guidelines: the need for improved implementation strategies. Healthc Manage Forum 2000;13(1):36-42.
Rogers EM. Diffusion of innovations. New York: Free Press; 1983.
Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996;312: 71-2.
Solberg LI. Guideline implementation: what the literature doesn't tell us. Jt Comm J Qual Improv 2000;26:525-37.
West S, King V, Carey T, et al. Systems to rate the strength of scientific evidence. Evidence Report/Technology Assessment Number 47. (Prepared by the RTI International-University of North Carolina Evidence-based Practice Center.) AHRQ Publication No. 02-E016, Rockville, MD: Agency for Healthcare Research and Quality. April 2002.

Web Sites

Agency for Healthcare Research and Quality (AHRQ)
http://www.ahrq.gov/
Centre for Evidence-Based Medicine (UK)
http://www.cebm.net/
Cochrane Collaboration
http://www.cochrane.org/
Etext on Health Technology Assessment (HTA) Information Resources
http://www.nlm.nih.gov/nichsr/ehta/
Evidence-based Medicine and Health Technology Assessment
http://www.nlm.nih.gov/nichsr/hsrsites.html#ebmhta
Health Information Research Unit, Evidence-Based Health Informatics
http://hiru.mcmaster.ca/
Health technology assessment on the Net: a guide to Internet sources of information
http://www.ahfmr.ab.ca/publication.html
National Guideline Clearinghouse
http://www.ngc.gov
Science.gov FirstGov for Science—Government Science Portal
http://www.science.gov/
World Wide Web-based EBM Hedges
http://www.mssm.edu/medicine/general-medicine/ebm/

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References

1. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-45.

2. Kohn LT, Corrigan JM, Donaldson MS, editors. To Err Is Human: Building a Safer Health System. A Report of the Committee on Quality of Health Care in America. Institute of Medicine. Washington, DC: National Academy Press, 2000.

3. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.

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Acknowledgments

Prepared for AHRQ by the EPC Coordinating Center under Contract No. 290-02-0006, Task 17.

Current as of January 2005

Internet Citation:

EPC Partner's Guide. January 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcpartner/